Complications Immediately after the Examination or after a Complaint Free Interval

Pain

Causes

► Neck: pharyngeal injury, esophageal perforation

► Chest: esophageal perforation, angina pectoris

► Abdomen: overdistension, perforation of the stomach or duodenum

Diagnosis

► Clinical findings

- Pharyngeal inspection, abdominal findings cutaneous emphysema,

► Radiographic findings

- Plain film of the neck and chest (cutaneous emphysema? air in mediastinum?)

- Standing abdominal plain film (free air?)

- Abdominal plain film in LLD (free air?)

► ECG if a cardiac cause is suspected

Treatment

► Further treatment according to cause (see below)

Esophageal Perforation

Risk factors

► Uncooperative patient

► Diverticula (especially Zenker diverticula), strictures, ulcers

► Osteophytes

► Interventions

► Bougie or balloon dilation, sclerotherapy of varices

Symptoms

► Cutaneous emphysema

Diagnosis

► Radiographic findings

- Plain film of chest and neck (free air?)

- Contrast examination of the esophagus (with water-soluble medium)

Treatment

► Surgical treatment

► Conservative treatment only in selected cases

► Antibiotics, proton pump inhibitor (PPI) i. v.

Perforation of the Stomach or Duodenum

Risk factors

► Duodenal diverticula

► Interventions (polypectomy, laser therapy)

Symptoms

► Pain (epigastric, diffuse), peritonism

► Diminished bowel sounds

► Fall in blood pressure, tachycardia, sweating

Diagnosis

► Radiographic findings

- Standing abdominal plain film (free air?)

- Abdominal plain film in LLD (free air?)

Treatment

► Surgical treatment

► Conservative treatment only in selected cases

► NPO, nasogastric tube

► Antibiotics, PPI

Pharyngeal Injury ► Otolaryngological diagnosis and treatment

Myocardial Ischemia ► Diagnosis and treatment according to established guidelines

Dyspnea

Causes

► Aspiration

► Cardiac decompensation

Symptoms

► Tachypnea? Cyanosis? Tachycardia?

Diagnosis

► Auscultation

► Arterial blood gas analysis

► Chest radiograph

Treatment

► According to cause (see below)

Aspiration or

Aspiration

Pneumonia

Risk factors

► Sedation, pharyngeal anesthesia

► Uncooperative patients, elderly patients

► Patients with swallowing difficulties, with multiple morbidity

► Emergency endoscopy

Symptoms

► Dyspnea, cyanosis

► Tachycardia, fever

Diagnosis

► Auscultation

- Fine or coarse rales

► Radiographs

- May be negative initially (!), diffuse patchy infiltration

Treatment

► Antibiotics (e.g., cefoxitin, tobramycin)

► O2 by nasal catheter; if no response, intubate and ventilate

Complications

► Global respiratory failure

► Adult respiratory distress syndrome (ARDS)

Cardiac

Decompensation

Risk factors

► Elderly patients

► Preexisting cardiovascular disease

Symptoms

► Dyspnea, tachycardia, frothy sputum

► Acrocyanosis

Diagnosis

► Auscultation

- Sometimes normal (!); moist rales, bronchospasm

► Radiographic findings

- Symmetrical hilar shadow, cardiac enlargement, Kerley B lines

- Ischemia? Arrhythmias?

Treatment

► O2 by nasal catheter

► Nitrates, furosemide

► Treatment of arrhythmia

► Antiangina therapy as required

Hematemesis,

Melena,

Hypovolemia

Risk factors

► Gastric and duodenal ulcer

► Thrombopenia, coagulation disorders, anticoagulant therapy

► Interventions (polypectomy, mucosectomy)

Symptoms

► Hematemesis

► Symptoms of hemorrhagic shock

Diagnosis

Treatment

► See relevant chapters.

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